The 30 326 deaths from lung cancer in England and Wales in 2008 represent 22% of the total mortality burden from cancer in that year.1 The next two most common causes of cancer death were colorectal cancer (10%) and breast cancer (8%). These familiar statistics outline the enormous impact that lung cancer continues to have on public health in the UK.

The dramatic fall in the prevalence of smoking in the UK over the last 60 years means that the lung cancer epidemic in the UK has peaked, particularly in men, and this is good news.2 In order to protect future generations of people in the UK from developing lung cancer, however, steps to drive down the prevalence of smoking as much as possible, and across all sectors of society, remains a pressing public health priority.3 4 This will inevitably need a broad spectrum of approaches.5 6

People who are currently at high risk of developing lung cancer, but do not yet have the disease, may benefit in the future if an effective screening programme can be developed to detect early subclinical disease. At the moment the use of CT imaging seems the approach most likely to succeed, but no trial yet has been able to demonstrate a reduction in mortality. A number of trials are currently ongoing, however, and more definitive evidence is expected between 2012 and 2016.7–13 Recently, a feasibility study for a randomised trial of CT screening in the UK has been completed and currently the arrangements are being finalised to undertake a pilot randomised trial. We hope that this project will stimulate more research in this area in the UK, including a trial powered to detect a mortality benefit of screening as well as research into the natural history of early lung cancer …